Coronavirus Update – July 29, 2020

Your coronavirus update for July 29; stay up to date with Elite.

More than 16.4 million cases of coronavirus (COVID-19) have been diagnosed worldwide as of Monday evening, including at least 652,000 deaths. Healthcare officials in the United States have reported at least 4.3 million positive COVID-19 cases and at least 150,000 deaths. Source: Johns Hopkins University & Medicine

CDC Reduces Isolation Protocol For “Mild” Coronavirus

Officials with the Centers For Disease Control and Prevention (CDC) have announced updated guidance for those diagnosed with mild-to-moderate COVID-19. Among the new guidelines is a reduced length of suggested quarantining to 10 days.

Available data indicate that persons with mild-to-moderate disease remain infectious no longer than 10 days after symptom onset, officials said. Persons with more severe-to-critical illness or those who are severely immunocompromised likely remain infectious no longer than 20 days after symptom onset. Recovered patients can continue to shed detectable COVID RNA in upper respiratory specimens for up to three months after illness onset, albeit at concentrations considerably lower than during illness, in ranges where replication-competent virus has not been reliably recovered and infectiousness is unlikely. The etiology of this persistently detectable RNA has yet to be determined, officials said. Studies have not found evidence that clinically recovered patients with persistence of viral RNA have transmitted COVID to others. These findings strengthen the justification for relying on a symptom-based, rather than test-based, strategy for ending isolation of these patients, so that persons who are by current evidence no longer infectious are not kept unnecessarily isolated and excluded from work or other responsibilities.

Additionally, reinfection has not yet been definitively confirmed in any recovered patients to date, according to CDC data. If, and if so, when, patients can be reinfected with COVID remains unknown and is a subject of investigation. 

The following updated recommendations are based on information available to the CDC as of mid-July, officials said:

  • For most persons with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms. Symptom onset is defined as the date on which symptoms first began, including non-respiratory symptoms.
  • A limited number of persons with severe illness may produce replication-competent virus beyond 10 days that may warrant extending duration of isolation and precautions for up to 20 days after symptom onset; consider consultation with infection control experts.
  • For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive test for RNA.
  • Role of polymerase chain reaction (PCR) testing to discontinue isolation or precautions. (PCR testing is defined as the use of an RT-PCR assay to detect the presence of COVID RNA.)
  • For persons who are severely immunocompromised, a test-based strategy could be considered in consultation with infectious disease experts. 
  • Role of PCR testing after discontinuation of isolation or precautions.
  • For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within three months after the date of symptom onset for the initial COVID-19 infection. In addition, quarantine is not recommended in the event of close contact with an infected person.
  • For persons who develop new symptoms consistent with COVID-19 during the three months after the date of initial symptom onset, if an alternative etiology cannot be identified by a provider, then the person may warrant retesting; consultation with infectious disease or infection control experts is recommended. Isolation may be considered during this evaluation based on consultation with an infection control expert, especially in the event that symptoms develop within 14 days after close contact with an infected person.
  • For persons who never developed symptoms, the date of first positive RT-PCR test for COVID RNA should be used in place of the date of symptom onset
  • Serologic testing should not be used to establish the presence or absence of COVID infection or reinfection.

FDA Announces More Sanitizers For Do-Not-Use List

The U.S. Food and Drug Administration (FDA) is making another set of warnings for both consumers and healthcare professionals to avoid the use of certain alcohol-based hand sanitizers due to the presence of methanol, a substance that can be toxic when absorbed through the skin and life-threatening when ingested. Methanol exposure can result in nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the nervous system, and/or death, officials said. Although people using these products on their hands are at risk for methanol poisoning, young children who ingest these products and adolescents and adults who drink these products as an alcohol (ethanol) substitute are most at risk. Those who have been exposed to hand sanitizer containing methanol and are experiencing symptoms should seek immediate medical treatment for potential reversal of the toxic effects of methanol poisoning. The FDA has also taken action to help prevent certain hand sanitizers from entering the United States by placing them on an import alert,1 officials said. The FDA is also reportedly working with manufacturers to recall products and is encouraging retailers to remove products from store shelves and online marketplaces. 

The FDA first warned about some of the methanol-containing hand sanitizers being sold in retail stores and online in June. The agency has now issued a further warning about an increasing number of adverse events, including blindness, cardiac effects, effects on the central nervous system, and hospitalizations and death, primarily reported to poison control centers and state departments of health. The agency continues to see these figures rise, officials said.

“We remain extremely concerned about the potential serious risks of alcohol-based hand sanitizers containing methanol,” said Stephen M. Hahn, MD, FDA commissioner. “Producing, importing, and distributing toxic hand sanitizers poses a serious threat to the public and will not be tolerated. The FDA will take additional action as necessary and will continue to provide the latest information on this issue for the health and safety of consumers.”

The agency’s do-not-use list2 is being updated regularly. In most cases, methanol does not appear on the product label, officials warn and say it’s important to not use any hand sanitizer products from the particular manufacturers on the list, even if the product or particular lot number is not listed, because some manufacturers are recalling only certain hand sanitizer products. Manufacturers’ failure to immediately recall all potentially affected products is placing consumers in danger of methanol poisoning, officials said. Additionally, the FDA is strongly urging distributors and retailers to stop distributing and selling hand sanitizers manufactured by the firms on the list immediately, even if that particular product is not included in a recall due to the risk of methanol poisoning.

When identifying hand sanitizers from the FDA’s do-not-use list, officials advise that looking for one or more identifiers from the list that match the product’s labeling is key, including: manufacturer name, product name, and National Drug Code number.

If anyone is in possession of these products, the FDA asks that disposals of the hand sanitizer bottle be done in a hazardous waste container, if available, or as recommended by local waste management and recycling centers. It is important to not flush or pour products down the drain or mix them with other liquids.

The FDA encourages healthcare professionals, consumers, and patients to report adverse events or quality problems experienced with the use of hand sanitizers to the FDA’s MedWatch Adverse Event Reporting program.3

Study Reveals Significance Of Symptom “Clusters”

A new study4 conducted by researchers in the United States, United Kingdom, and Sweden has found that COVID-19 presents in six different “clusters” of symptoms that may help predict which patients are more at risk and in need of respiratory support.

The identified clusters include:

  1. (“Flulike” with no fever): Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever
  2. (“Flulike” with fever): Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite
  3. (Gastrointestinal): Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough
  4. (Severe level 1, fatigue): Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue
  5. (Severe level 2, confusion): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain
  6. (Severe level 3, abdominal and respiratory): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain

For the study, researchers used a machine learning algorithm to analyze data from more than 1,600 patients in the U.S. and the U.K. Researchers then tested the algorithm by using it on an additional 1,047 patients in the U.S., U.K. and Sweden who reported symptoms throughout May.

References

  1. Import alert 66-78. FDA. 2020. Accessed online: www.accessdata.fda.gov/cms_ia/importalert_1166.html
  2. FDA updates on hand sanitizers with methanol. FDA. 2020. Accessed online: www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-methanol#products
  3. Medwatch: the FDA safety information and adverse event reporting program. FDA. 2020. Accessed online: www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program
  4. 4. Sudre CH, Lee KA, Lochlainn MN. Symptom clusters in covid-19: a potential clinical prediction tool from the covid symptom study app. BMJ Yale. 2020. DOI: https://doi.org/10.1101/2020.06.12.20129056

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